Impact of Coaching on Medical Students During Their Clinical Clerkship: A Mixed-Methods Study

Abstract

Background

In undergraduate medical education, clinical clerkships (CC) serve as a platform for acquiring the integrated competencies essential to physicians. Simultaneously, CC plays a crucial role in facilitating a smooth transition to postgraduate training and preventing burnout. This study aims to elucidate the effects of coaching on medical students during CC, with particular focus on self-efficacy and resilience.

Methods

This was a mixed-methods study based on an explanatory sequential design. The participants were fifth-year medical students who underwent CC at Chiba University Hospital in Japan between June and October 2021. They received four weeks of one-on-one coaching during one department’s CC by other attending physicians trained as coaches. The participants answered self-assessment web questionnaires using the Japanese version of the Generalised Self-Efficacy Scale (GSE-J) and the Brief Resilience Scale Japanese version (BRS-J) before and after coaching. In addition, they participated in semi-structured focus group interviews related to the effects of coaching. Narrative data were analysed using qualitative content analysis.

Results

Fifteen medical students participated in the study. The mean GSE-J and BRS-J scores (n = 13) significantly increased after coaching (from 71.0 (11.7) to 77.5 (16.2), p = 0.018, Cohen’s d = 0.76, Hedges’ g = 0.71 and from 18.5 (4.7) to 21.4 (4.1), p = 0.019, Cohen’s d = 0.75, Hedges’ g = 0.70, respectively). Four focus group interviews were conducted. The effects of coaching were classified into eight categories (goal setting and milestones, positiveness, verbalisation, self-confidence, proactivity, good communication, dealing with difficulties, and reflection and metacognition) related to self-efficacy and resilience.

Conclusions

Medical students who receive coaching during CC improved their self-efficacy and resilience. Combining coaching with regular training in CC might serve as a useful educational strategy in terms of a smooth transition to postgraduate training and preventing burnout.

Keywords

clinical clerkship coaching mixed method resilience self-efficacy

Background

In undergraduate medical education, clinical clerkship (CC) is an important learning opportunity to acquire the integrated competencies necessary for physicians through on-the-job training.¹ Objective endpoints of CC are associated with medical students’ preparedness to transition for beginning medical practice as physicians after graduation.² To enhance the learning effectiveness of CC, it is crucial that medical students participate in real patient care and that supervising physicians engage in supportive dialogue with them.³ Furthermore, self-efficacy in senior medical students contributes to their preparedness for clinical practice.⁴ However, in actual CC, issues such as limited teaching time, insufficient feedback and environments, and inappropriate supervision models have been reported.^5,6 In addition, medical students undergoing CC and resident physicians are at high risk of burnout,^7,8 and resilience is crucial for its prevention.^7,9 Therefore, CC requires supportive and efficient educational methods that not only involve medical students in clinical practice but also enhance their self-efficacy and resilience, anticipating postgraduate training.

In recent years, coaching has garnered increased attention in physician training. Coaching is a dialogue-based support approach that has gained widespread popularity in medical education.¹⁰ The main characteristic of coaching is individual support, including goal setting, providing feedback, and facilitating the development of new behaviours, insights, and approaches.^10,11 Many studies have reported the usefulness of coaching in improving the surgical skills,¹² professional identity formation,^13,14 and well-being and resilience^15-18 of medical students and physicians. However, the impact of coaching on self-efficacy in medical education has been limited to specific groups such as lower-year medical students.¹⁹

The development of self-efficacy occurs through experiences like observing role models or receiving feedback²⁰ and medical students’ resilience development is influenced not only by personal factors but also by institutional factors such as supportive learning environments and strengthened relationships between faculty and students.²¹ The CC plays a significant role in the transition from pre-graduate to postgraduate medical education² and educational approaches that cultivate self-efficacy and resilience from the pre-graduate stage are thus important. Coaching provides a space for processing feedback and experiences through individualised, interactive dialogue, while also strengthening the relationship between educator and learner.¹⁰ For these reasons, we hypothesised that coaching may be particularly useful for enhancing medical students’ self-efficacy and resilience during CC. Therefore, we trained supervising physicians as coaches and conducted coaching on a trial basis within the CC curriculum. The objective of this study is to implement coaching for medical students during CC and to verify its impact on their acceptance, self-efficacy, and resilience.

Methods

Study Design

We conducted a mixed-method study that incorporates quantitative and qualitative techniques based on a sequential explanatory design at a single site.²² This approach enables researchers to better understand experimental results by integrating the participants’ viewpoints. The National Institutes of Health recommends using a mixed-method research approach to enhance data quality and scientific rigor and to address the complex challenges currently confronting health sciences, including health-professional education, more effectively.^23,24 The initial quantitative arm of this study was the Japanese version of the Generalised Self-Efficacy Scale (GSE-J), developed through the translation of Sherer’s Self-Efficacy Scale^25,26 and the Japanese version of the Brief Resilience Scale (BRS-J), developed through the translation of the Brief Resilience Scale,^27,28 before and after four weeks of coaching, with documented reflections after each session. We then conducted focus group interviews (FGIs) in the qualitative arm based on the results of the preceding quantitative arm (Figure 1). This study conformed to the DoCTRINE and COREQ guidelines (Supplemental Materials 1 and 2).^29,30

Figure 1.

Study design: Explanatory sequential design

Study Setting and Participants

In Japan, Medical schools offer a six-year curriculum and CC has taken place in the last two years.³¹ Chiba University’s School of Medicine has approximately 120 medical students per academic year. The CC begins in December of the fourth year and ends in October of the sixth year. In the CC, groups of 7 to 11 medical students rotate from one department to another every four weeks (e.g. internal medicine, surgery, paediatrics, obstetrics and gynaecology, emergency, and intensive care unit). Eligible participants were fifth-year medical students who underwent CC at Chiba University Hospital between June and October 2021 and volunteered to participate in this study. The exclusion criterion was having prior experience with coaching. We contacted participants via Zoom^TM and by email. Written informed consent to participate in this study was obtained from all participants.

Training of Coaches

Coaches were trained by two physicians, including the first author, who had completed a coach training program (coachAcademia, formerly CTP provided by COACH A Co., Ltd.) meeting the requirements set by the International Coach Federation. Trainees were originally 6 attending physicians from different departments at Chiba University Hospital who were interested in coaching and were also co-authors of this study. The coach training period lasted one year, during which the trainees studied relevant books and received ten sessions each of one-on-one coaching and mentor coaching in person or via Zoom^TM from the two trainers. The duration of each session was approximately 30 to 60 minutes. At the conclusion of the mentor coaching session, the trainers conducted a performance assessment of the trainees based on the International Coaching Federation Core Competencies.³²

Coaching for Participants During CC

The first author reviewed the overall coaching plan for medical students during CC. The trained coaches were allocated to the participants to ensure that they differed from the attending or supervising physicians in each CC department. The participants were briefed in advance by the first author on the study aims, co-researchers, and the key characteristics of coaching. The explanation emphasised that the participants would decide their own goals and actions and that their coach would support them in behavioural changes without offering instructions or advice. Subsequently, the participants received weekly one-on-one coaching in four sessions (i.e., over four weeks) in one department. Coaching was conducted on Zoom^TM, considering the COVID-19 pandemic, and each session lasted approximately 30 min. After each coaching session, the participants documented their weekly reflections online and shared them with their coach. To standardise the coaching process, the first author distributed manuals to the coaches that outlined that they should set a four-week CC goal during the first session; conduct dialogues based on the Goal, Realty or Resources, Options, Will (GROW) model³³ in every session to encourage self-directed action; and review the past four weeks and assess the degree to which the goals were achieved during the final session. In addition, the first author monitored the progress of the coaching sessions and was available to respond to inquiries from the coaches. Coaching was conducted between June and October 2021. All participants received four coaching sessions.

Data Collection

Quantitative Data Collection

We conducted an online questionnaire survey of the participants before and after all coaching sessions (May and October 2021). The online questionnaire included the GSE-J and BRS-J.

GSE-J

The GSE-J consists of 23 items rated on a five-point Likert scale (Supplemental Material 3). The total score for each scale ranges from 23 to 115 and average score (standard deviation: SD) by gender in the Japanese community sample is 77.93 (13.93) for men and 75.31 (13.42) for women, respectively.²⁶

BRS-J

The BRS-J consists of six items rated on a five-point Likert scale (Supplemental Material 4).²⁸ The total score for each scale ranges from 6 to 30.

Qualitative Data Collection

After all the coaching sessions and quantitative data collection of the participants were completed, we conducted semi-structured FGIs with the same participants to deepen the results of an earlier quantitative study. Focus groups enhance the depth of expression and facilitate the exchange of information on shared topics, especially when participants have a similar level of familiarity with the subject and the power dynamics among them are minimal.³⁴ The FGIs were held in four sessions with 13 of the 15 consenting participants. The FGIs were conducted by three male physician researchers (HY, HK, and KS), who were acquainted with the participants and taught various clinical medicine courses. An interview guide (Supplemental Material 5), which was validated by four researchers (HY, HK, KS, and SI) before data collection, was used for the FGIs. Questions were designed to explain the results of the preceding quantitative data (changes in self-efficacy and resilience after coaching in CC). The FGIs took no longer than 60 min and considered the impact of CC and participant fatigue. We used our workplace Zoom^TM video recording system to record the FGIs with the participants’ permission. The FGIs were transcribed verbatim, while ensuring participants’ anonymity by avoiding identification.

As the researchers who had been involved in promoting coaching in medical education, we were constantly mindful that this stance could influence participants’ responses and made every effort to listen carefully to the concerns expressed. Furthermore, to minimise bias, we ensured that researchers who had directly coached the participants did not attend the FGIs.

Data Analysis

Statistical Analysis

Quantitative data were expressed as mean (standard deviation [SD]), unless otherwise indicated. A paired t-test was used to compare the parameters before and after all coaching sessions. Statistical significance was set at p < 0.05. To support the interpretation of the results, the effect size was calculated retrospectively as Cohen’s d for paired samples (mean difference divided by the SD of the differences).³⁵ Furthermore, Hedges’ g was used as a bias-corrected estimate to account for the small sample size.³⁶ All statistical analyses were performed with EZR (Saitama Medical Centre, Jichi Medical University, Saitama, Japan),³⁷ which is a graphical user interface for R (The R Foundation for Statistical Computing, Vienna, Austria). More precisely, it is a modified version of R commander designed to add statistical functions frequently used in biostatistics.

Content Analysis

Based on the paradigm of constructivism, we used qualitative content analysis to analyse FGIs transcripts, in line with previous studies.³⁸ This analysis comprised descriptions of the manifest content and interpretations of latent content.³⁹ HY and KS (medical educators) independently read and coded all transcripts. Both were experienced in conducting qualitative studies relevant to content analysis. Subsequently, they discussed, identified, and agreed on the coding of descriptors. The transcripts were thoroughly read and analysed using an inductive and deductive coding approach until agreement on coding was achieved by the two researchers.⁴⁰ Data saturation was defined as the point at which no new codes or themes emerged from the data. After the coding agreement, another author (HK) participated in the discussion. The categories and subcategories were regularly discussed and reviewed for content by HK, who has extensive experience in qualitative research, to ensure the credibility of the findings. Furthermore, the analysis results were reviewed and discussed by researchers (YM, YK, MA, and SI) who were not responsible for coaching medical students or involved in promoting coaching.

Ethical Consideration and Approval

The study’s description stated that participation was voluntary and did not affect the medical students’ grades. Medical students who agreed to participate completed the questionnaires and FGIs. This study was approved by the Ethics Committee of Chiba University (approval no. 3425). The study database was anonymised.

Results

Fifteen medical students participated in the study and received coaching during the CC period from June to October 2021. Their mean (SD) age was 23.1 (1.0) years and 60.0% (n = 9) were men.

Quantitative Outcomes and Measures

In total, 13 participants completed the questionnaire. The score (SD) of the GSE-J of participants increased significantly after coaching, from 71.0 (11.7) to 77.5 (16.2), (p = 0.018, Cohen’s d = 0.76. Hedges’ g = 0.71). Furthermore, the final mean score (SD) of the BRS-J increased significantly after coaching, from 18.5 (4.7) to 21.4 (4.1) (p = 0.019, Cohen’s d = 0.75, Hedges’ g = 0.70).

Content Analysis

Although two medical students were subsequently lost to follow-up, four semi-structured FGIs were conducted (n = 13) after completing the questionnaire. No substantially new codes or themes emerged from the collected data in the fourth FGI. Following discussion, we reached a consensus that the data had reached saturation. The average duration of the FGIs was 41 minutes and 92 codes were extracted. We identified eight categories and 24 subcategories regarding the effectiveness of coaching and its impact on self-efficacy and resilience during CC. Furthermore, we classified these eight categories into three themes: those primarily related to self-efficacy, those related to both self-efficacy and resilience, and those primarily related to resilience (Table 1).

Table 1.

Frequencies of Codes for Each Category and Subcategory From Content Analysis. () Number of Codes

Theme	Category	Subcategory	Quotes
Categories related to self-efficacy (43)	Goal settings and milestones (21)	Goal settings (8)	“When I remembered the goals I set in CC, I was able to take action to achieve them.”(ID-11)
		Action plans (5)	“When setting goals, coaching considered the actions to be taken to achieve them.” (ID-11)
		Subdivision of practice (3)	“I started to think about things in one-week increments and work on the CC.” (ID-9)
		Setting milestones (3)	“I now know what I want to do and I know what I need to do to achieve it.” (ID-10)
		Advanced preparations (2)	“My thinking changed to make use of face-to-face chances by preparing questions” (ID-13)
	Positiveness (12)	Positive thinking (9)	“After coaching, I felt that presentation in front of patients was an opportunity.” (ID-9)
	Positiveness (12)	Positive goal settings (3)	“I don’t really feel like it, but I feel like it was good to set positive goals.” (ID-6)
	Verbalisation (10)	Verbalisation tasks (5)	“Once I could see my task, I was able to confront the things I tended to run away from.” (ID-2)
		Verbalisation goals (3)	“By talking about my goal, I realised I had been vague about what I wanted to achieve.” (ID-12)
		Verbalisation of own thoughts (2)	“My own thoughts about the current CC were visualised in words.” (ID-6)
Categories related to self-efficacy and resilience (31)	Self-confidence (14)	Successful experiences (6)	“I felt more confident when I was able to achieve the goals that I set for myself.” (ID-11)
		Release from pressure (5)	“I became less frightened the first time and less fearful of failure.” (ID-8)
		Improving learning outcomes (1)	“I have learnt more from my CC.” (ID-8)
		Self-esteem through empathy (1)	“My coach empathised with me, which gave me confidence.” (ID-6)
		Motivation (1)	“I felt more strongly that I need to study each of these issues.” (ID-10)
	Proactivity (11)	Active participation in CC (8)	“I started to participate in what I found somewhat troublesome and avoidable during the CC.” (ID-6)
		Attitude of valuing opportunities (2)	“I was able to successfully own that I had prepared by accident.” (ID-2)
		Self-learning (1)	“If I had not been coached, I might have neglected my self-study.” (ID-13)
	Good communication (6)	Regular dialogue (4)	“The opportunity to speak to my coach each week gave me time to think about my CC.” (ID-13)
	Good communication (6)	Good communication with patients (2)	“I no longer feel uncomfortable talking to my patient in charge.” (ID-2)
Categories related to resilience (18)	Dealing with difficulties (11)	Attempts to overcome difficulties (6)	“I have developed a habit of thinking critically, which has enabled me to overcome difficulties.” (ID-9)
	Dealing with difficulties (11)	Mindset to face challenges (5)	“I started to think about what to do in difficult times.” (ID-8)
	Reflection and metacognition (7)	Reflection (5)	“I started to think more closely about how I feel and how to overcome challenges.” (ID-9)
	Reflection and metacognition (7)	Metacognition (2)	“I became aware of my own thinking through coaching.” (ID-6)

Theme 1: Categories Related to Self-Efficacy

The category with the highest number of codes was ‘Goal setting and milestones’. Medical students found that setting CC goals and milestones clarified their action processes, leading to increased self-awareness and preparatory actions. Moreover, according to the categories of positiveness and verbalisation, medical students objectively assessed their own state and goals through verbalisation, viewing the CC learning environment positively.

Theme 2: Categories Related to Self-Efficacy and Resilience

The category with the highest number of codes was ‘Self-confidence’. Medical students gained self-confidence through successful experiences and emotional support from coaches, lowering the psychological barriers to new challenges in CC, while developing a deep recognition of the necessity for learning. However, in terms of proactivity and good communication, medical students were actively and objectively seizing opportunities to learn, while engaging with their patients in charge.

Theme 3: Categories Related to Resilience

Through the two categories of ‘Dealing with difficulties’ and ‘Reflection and metacognition’, medical students were found to enhance their own reflection and metacognition, enabling them to understand challenges encountered during CC from new perspectives and consider options for action.

Discussion

This study examined the effects of coaching on medical students during CC, focusing on their self-efficacy and resilience. This study had two main findings. First, medical students who received coaching during CC demonstrated improved self-efficacy and resilience, as shown by medium effect size based on Cohen’s conventional thresholds (0.2 small, 0.5 medium, and 0.8 large).⁴¹ Second, content analysis showed that these changes were associated with setting goals and milestones, positiveness, verbalisation of tasks or one’s own thoughts, gaining self-confidence and proactivity, good communication with coaches and patients, dealing with difficulties, and reflection and metacognition.

Previous study reported that 6-weeks of coaching during obstetrics and gynaecology clerkship improved medical students’ adaptability and proactivity performance.⁴² The participants of our study engaged in CC across various departments, indicating that coaching might be effective beyond departmental boundaries. A prospective study showed that executive/life coaching for first-year medical students improved self-efficacy regarding stress management.¹⁹ Furthermore, an interview survey of first-year life science students revealed that verbalisation through self-coaching for solving challenging problems enabled students to couple their metacognitive skills and self-efficacy to persist when faced with difficulties.⁴³ Based on these previously reported findings and the results of our content analysis, coaching is presumed to mutually enhance self-efficacy and resilience. In addition, our study targeted medical students rather than physicians and found that both self-efficacy and resilience improved within a shorter intervention period than previously reported.^16-19,42 Two possible reasons for this outcome are considered: First, we implemented systematic coaching by properly trained coaches, which differed from the usual supervising physicians. Second, the participants recorded weekly reflections during the coaching period, which may have further enhanced their metacognition.

In CC, combining coaching with regular training has the potential to enhance medical students’ self-efficacy and resilience—key factors for their smooth transition to postgraduate training and burnout prevention^4,7,8—making it a useful educational strategy. However, the challenge remains that supervising physicians have few opportunities to learn coaching and that mastering it takes considerable time.

This study has several limitations. First, as it was conducted at one university hospital in Japan, the results are subject to cultural bias and the participants’ learning environments. Second, the number of enrolled participants was small, and no sample size calculation was performed. Consequently, the universal application of our findings is limited. Third, the coaching implementation and follow-up periods of the participants were short, and the long-term effects of coaching were not tested. Fourth, in the current study, we only examined the general self-efficacy scale, which is independent of specific situations and tasks. Therefore, we could not adequately assess medical students’ self-efficacy in the specific context of CC. Fifth, as we did not include a control group in our comparison, we could not rule out the possibility that the CC experience, maturation effects, or other educational experiences during the same period contributed to improvements in the medical students’ self-efficacy and resilience. Further studies are required using CC-specific scales with more participants, a control group, and longer follow-up periods across facilities and regions.

Conclusions

Our study showed that medical students who received systematic coaching during CC increased their self-efficacy and resilience. Combining coaching with regular training in CC might serve as a useful educational strategy for medical students, facilitating a smooth transition to postgraduate training and preventing burnout.

Supplemental Material

Supplemental Material - Impact of Coaching on Medical Students During Their Clinical Clerkship: A Mixed-Methods Study

Supplemental Material for Impact of Coaching on Medical Students During Their Clinical Clerkship: A Mixed-Methods Study by Hidetaka Yokoh, Kiyoshi Shikino, Hajime Kasai, Masato Kanda, Atsuhiko Sugiyama, Tomoko Tsukamoto, Hanae Wakabayashi, Yohei Matsumoto, Yasuhiko Kimura, Mayumi Asahina, Shoichi Ito in Journal of Medical Education and Curricular Development

Supplemental Material

Supplemental Material - Impact of Coaching on Medical Students During Their Clinical Clerkship: A Mixed-Methods Study

Supplemental Material

Supplemental Material - Impact of Coaching on Medical Students During Their Clinical Clerkship: A Mixed-Methods Study

Footnotes

Acknowledgements

We would like to thank the medical students who participated in this study. Our heartfelt thanks also go to Dr. Shunichiro Onishi, a professional coach, for his valuable assistance in training coaches. We would also like to thank Editage (www.editage.com) for English language editing.

ORCID iDs

Hidetaka Yokoh

Kiyoshi Shikino

Hajime Kasai

Masato Kanda

Atsuhiko Sugiyama

Tomoko Tsukamoto

Hanae Wakabayashi

Yohei Matsumoto

Yasuhiko Kimura

Mayumi Asahina

Shoichi Ito

Ethical Considerations

This study was approved by the Ethics Committee of Chiba University (Approval No. 3425).

Consent to Participate

Written informed consent to participate in this study was obtained from all participants.

Author Contributions

HY contributed to the study design, sample analysis, data interpretation, and manuscript writing. KS, HK, MK, AS, HW, and TT contributed to the data acquisition. YM, YK, MA, and SI conceived the study design, interpreted the data and revised the original draft. All the authors have read and approved the final version of the manuscript.

Funding

The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This study was supported by the JSPS KAKENHI (Grant No. 19K10505).

Declaration of Conflicting Interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Data Availability Statement

The datasets generated and/or analysed in the current study are available from the corresponding author upon reasonable request. Sensitive responses to focus group interviews from participants are not publicly available because they are considered confidential information.*

Supplemental Material

Supplemental material for this article is available online.

Appendix

References

Spencer

. Learning and teaching in the clinical environment. BMJ. 2003;326:591-594. doi:10.1136/bmj.326.7389.591.

Chaou

Chang

, et al. The evolution of medical students’ preparedness for clinical practice during the transition of graduation: a longitudinal study from the undergraduate to postgraduate periods. BMC Med Educ. 2021;21(1):260. doi:10.1186/s12909-021-02679-8.

Steven

Wenger

Boshuizen

Scherpbier

Dornan

. How clerkship students learn from real patients in practice settings. Acad Med. 2014;89(3):469-476. doi:10.1097/ACM.0000000000000129.

Jebram

Harendza

. Relationships between self-efficacy beliefs and personal factors in final-year medical students. BMC Med Educ. 2024;24(1):1104. doi:10.1186/s12909-024-06087-6.

Oliveira Franco

Martins Machado

Satovschi Grinbaum

Martiniano Porfírio

. Barriers to outpatient education for medical students: a narrative review. Int J Med Educ. 2019;10:180-190. doi:10.5116/ijme.5d76.32c5.

Cho

Lee

Jung

. Barriers and future improvements of workplace-based learning in Korean medicine clinical clerkship: perspectives of graduates. BMC Med Educ. 2024;24(1):566. doi:10.1186/s12909-024-05288-3.

Sanjaya

Mianto

Wijayanto

Edwin

. Resilience: a panacea for burnout in medical students during clinical training?: a narrative review. Medicine. 2024;103(49):e40794. doi:10.1097/md.0000000000040794.

Dyrbye

West

Satele

, et al. Burnout among U.S. medical students, residents, and early career physicians relative to the general U.S. population. Acad Med. 2014;89(3):443-451. doi:10.1097/ACM.0000000000000134.

Lin

C-D

Lin

BY-J

Chen

D-Y

. Medical students’ resilience: a protective role on stress and quality of life in clerkship. BMC Med Educ. 2019;19:473. doi:10.1186/s12909-019-1912-34.

10.

Lovell

. What do we know about coaching in medical education? A literature review. Med Educ. 2018;52(4):376-390. doi:10.1111/medu.13482.

11.

Launer

. Supervision, mentoring and coaching. In: Swanwick

, ed. Understanding Medical Education, Theory and Practice. 2nd ed. John Wiley & Sons; 2013:111-122.

12.

Daniel

McKechnie

Kruse

, et al. Video-based coaching for surgical residents: a systematic review and meta-analysis. Surg Endosc. 2023;37(2):1429-1439. doi:10.1007/s00464-022-09379-4.

13.

de Lasson

Just

Stegeager

Malling

. Professional identity formation in the transition from medical school to working life: a qualitative study of group-coaching courses for junior doctors. BMC Med Educ. 2016;16:165. doi:10.1186/s12909-016-0684-3.

14.

Parsons

Kon

Plews-Ogan

Gusic

. You can have both: coaching to promote clinical competency and professional identity formation. Perspect Med Educ. 2021;10(1):57-63. doi:10.1007/s40037-020-00612-1.

15.

Dyrbye

Gill

Satele

West

. Professional coaching and surgeon well-being: a randomized clinical trial. Ann Surg. 2023;277(4):565-571. doi:10.1097/SLA.0000000000005678.

16.

Mann

Shah

Thibodeau

, et al. Online well-being group coaching program for women physician trainees: a randomized clinical trial. JAMA Netw Open. 2023;6(10):e2335541. doi:10.1001/jamanetworkopen.2023.35541.

17.

Kiser

Sterns

Lai

Horick

Palamara

. Physician coaching by professionally trained peers for burnout and well-being: a randomized clinical trial. JAMA Netw Open. 2024;7(4):e245645. doi:10.1001/jamanetworkopen.2024.5645.

18.

Johnson

Pointon

Talbot

, et al. Reboot coaching programme: a mixed-methods evaluation assessing resilience, confidence, burnout and depression in medical students. Scott Med J. 2024;69(1):10-17. doi:10.1177/00369330231213981.

19.

Cameron

Dromerick

Ahn

Dromerick

. Executive/life coaching for first year medical students: a prospective study. BMC Med Educ. 2019;19(1):163. doi:10.1186/s12909-019-1564-4.

20.

Bandura

. Self-efficacy: toward a unifying theory of behavioral change. Psycol Rev. 1977;84:191-215.

21.

Azim

Yusoff

MSB

Roslan

. Mapping the multidimensional factors of medical student resilience development: A scoping review. BMC Med Educ. 2025;25(1):744. doi:10.1186/s12909-025-07290-9.

22.

Creswell

. A Concise Introduction to Mixed Methods Research. Thousand Oaks, CA: SAGE Publications; 2015.

23.

Dowding

. Review of the book, ‘Best practices for mixed methods research in the health sciences’, by Creswell JW, Klassen AC, Plano Clark VL, Smith KC. Qual Soc Work. 2013;12(4):541-5.19.

24.

Creswell

Plano Clarck

. Designing and Conducting Mixed Method Research. 3rd ed. Sage Publications, Inc.; 2017.

25.

Sherer

Maddux

Mercandante

Prentice-Dunn

Jacobs

Rogers

. The self-efficacy scale: construction and validation. Psychol Rep. 1982;51:663-671.

26.

Narita

Shimonaka

Nakazato

Kawai

Sato

Osada

. A Japanese version of the generalized self-efficacy scale: scale utility from the life-span perspective. Jpn J Educ Psychol. 1995;43:306-314. (in Japanese). https://www.jstage.jst.go.jp/article/jjep1953/43/3/43_306/_pdf/-char/ja. Accessed 21 January 2026.

27.

Smith

Dalen

Wiggins

Tooley

Christopher

Bernard

. The brief resilience scale: assessing the ability to bounce back. Int J Behav Med. 2008;15:194-200.

28.

Tokuyoshi

Moriya

. Development and validation of the Brief Resilience Scale. Japanese version (BRS-J). 2015. (In Japanese). https://www.jstage.jst.go.jp/article/pacjpa/79/0/79_1EV-055/_pdf/-char/ja. Accessed 21 January 2026.

29.

Blanco

Prunuske

DiCorcia

Learman

Mutcheson

Huang

. The DoCTRINE guidelines: defined criteria to report innovations in education. Acad Med. 2022;97(5):689-695. doi:10.1097/ACM.0000000000004634.

30.

Tong

Sainsbury

Craig

. Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. Int J Qual Health Care. 2007;19(6):349-357. doi:10.1093/intqhc/mzm042.

31.

Nishigori

. Medical education in Japan. Med Teach. 2024;46(sup1):S4-S10.

32.

International Coaching Federation . ICF Core Competencies. https://coachingfederation.org/resource/icf-core-competencies/. Accessed 21 January 2026.

33.

Whitmore

. Coaching for Performance. The Principles and Practice of Coaching and Leadership. 5th ed. John Murray Business; 2010.

34.

Stalmeijer

Mcnaughton

Van Mook

WNKA

. Using focus groups in medical education research: AMEE Guide No. 91: AMEE guide no. 91. Med Teach. 2014;36:923-939. doi:10.3109/0142159X.2014.917165.

35.

Cohen

. Statistical Power Analysis for the Behavioral Sciences. 2nd ed. Routledge; 1988. 10.4324/9780203771587.

36.

Hedges

Olkin

. Statistical Methods for Meta-Analysis. Academic Press; 1985.

37.

Kanda

. Investigation of the freely available easy-to-use software ‘EZR’ for medical statistics. Bone Marrow Transplant. 2013;48:452-458. doi:10.1038/bmt.2012.244.

38.

Elo

Kyngäs

. The qualitative content analysis process. J Adv Nurs. 2008;62:107-115. doi:10.1111/j.1365-2648.2007.04569.x.

39.

Graneheim

Lindgren

Lundman

. Methodological challenges in qualitative content analysis: a discussion paper. Nurse Educ Today. 2017;56:29-34. doi:10.1016/j.nedt.2017.06.002.

40.

Worobetz

O’Regan

Casey

, et al. Lessons learned from a pandemic: implications for a combined exercise and educational programme for medical students. BMC Med Educ. 2022;22:255. doi:10.1186/s12909-022-03290-1.

41.

Durlak

. How to select, calculate, and interpret effect sizes. J Pediatr Psychol. 2009;34(9):917-928. doi:10.1093/jpepsy/jsp004.

42.

Guseh

Chen

Johnson

. Can enriching emotional intelligence improve medical students’ proactivity and adaptability during OB/GYN clerkships? Int J Med Educ. 2015;6:208-212. doi:10.5116/ijme.5658.0a6b.

43.

Halmo

Yamini

Stanton

. Metacognition and self-efficacy in action: how first-year students monitor and use self-coaching to move past metacognitive discomfort during problem solving. CBE Life Sci Educ. 2024;23(2):ar13. doi:10.1187/cbe.23-08-0158.

Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.

0.19 MB

0.02 MB

0.15 MB

0.00 MB